Migraine is usually readily identifiable from the history, although unusual variants of migraine are present that can cause uncertainty. Throbbing pain usually occurs on one side of the head but can also be experienced at one point in the head, in the forehead, or even in the whole head.
Two major types of migraine; migraine with auras (classic) and without auras (common) only differ in the pre headache symptoms that are present in classic migraines but are absent in common migraines. Auras come up as warning signs 15 to 20 minutes (in some cases) a day before a migraine, these include visual symptoms and phonophobia and are followed by a migraine attack. Mentioned below are some major and other types of migraines.
- Migraine without auras
- Migraine with auras
- Isolated auras
- Chronic migraines
- Migraine in children
- Migraine in pregnancy
- Hemiplegic migraine
- Ocular migraines
- Basilar migraine
- Vestibular migraine
- Period migraine
- Probable migraine
- Stress migraine
- Home remedies
Major types of migraine
- Migraine without auras (Common migraines)
2. Migraine with auras (Classic migraines)
1. Migraine without auras
80% of the population experience characteristic headaches but no auras and are known as migraines without auras. Migraines often run in families and have a genetic predisposition. Although painful migraines without auras are not life-threatening.
Migraines are caused due to vasodilation of blood vessels in the scalp (extracranial blood vessels) due to hypothalamic activity and the release of chemicals called neurotransmitters like serotonin.
- Throbbing or steady pain
- Nausea and vomiting
- Irritability and low mood
- Low blood pressure
- Sensitivity to light and sound
2. Migraine with auras
The auras in migraine may manifest as almost any neurological symptom but are most often visual sometimes leaving behind a trail of temporary visual field loss (scotoma). Sensory symptoms spreading over 20 to 30 minutes from one part of the body to another are more common than motor ones. These have all the features of a common migraine with some additional neurological symptoms like photophobia and phonophobia that are followed by a migraine attack.
The cause of migraine with auras is unknown but there is evidence that the auras occur due to dysfunctional ion channels causing depolarization and hyperpolarization at the cortical front. This process spreads over the cortex at the rate of about 3mm/min which is roughly the time of aura’s symptomatic spread.
- Severe headache, throbbing in character
- Nausea and vomiting
- Auras: Fortification spectra , teichopsia
- Shimmering, silvery, zigzag lines marching across the visual fields.
- A temporary visual field loss (in some cases)
- Ringing in the ears
- Photophobia and phonophobia
An episode of migraine lasts from 4 to 72 hours where movement makes the pain worse and the patient prefers to lie in a quiet dark room.
In some cases, people are reported to have experienced isolated auras where the neurological symptoms may occur but are not followed by any headache. This is also called an Acephalgic migraine. A person only experiences lightning strikes in front of the eyes, ringing of ears, or temporary visual loss which is never followed by a headache.
If you suffer from a migraine attack 15 or more days a month for at least three months, this classifies as a chronic condition and needs special medical attention. You should see your physician as soon as possible.
Migraine in children
Children also experience migraines just as adults but their pain location may vary sometimes. They are less likely to experience pain at the back of the head whereas mostly front or one side of the head is involved. Along with the headache, they also come across visual auras, episodes of depression, and mood disorders. Thus, should be addressed as soon as possible.
Migraine in pregnancy
Most women stop getting migraines during pregnancy due to a balance in the hormone levels. However, a few who experience migraines should be more cautious. In this case, migraines can be triggered due to high blood pressure or any other hemostatic change that may also prove harmful for the baby. According to several pieces of research conducted across the globe, acetaminophen is the safest to consume during pregnancy for migraines. If you are pregnant and experiencing frequent migraine attacks, you should consult your physician before taking any sort of medication.
The management of both types of migraines is the same. While there are some additional measures you need to take if your migraines are becoming more frequent and taking up a chronic form, which includes booking an appointment with your physician as soon as possible.
Treatment of an acute attack:
- Analgesics: aspirin, paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs)
- Antiemetic for nausea: metoclopramide, domperidone
- Triptans: sumatriptan is administered by an oral subcutaneous or nasal route for severe attacks
- Prophylactics: vasoactive drugs (beta-blockers), antidepressants, and antiepileptics are given to people who experience frequent attacks
Management using Excedrin:
Excedrin is a drug used to combat severe migraine headaches. A single dose of this drug has proved relief in patients with moderate to severe headache.
This is a combination of acetaminophen, aspirin, and caffeine.
Two caplets of excedrin are generally recommended by physicians in 24 hours for severe migraines. The dosage is based on severity and response to the drug thus a physician’s recommendation is required before taking the tablet.
This should be avoided if
- You have aspirin-induced asthma
- Blood disorders like anemia
- Ulcers, kidney disease, gout
- Anxiety disorders, insomnia
This should not be taken with mifepristone, ketorolac because it causes a severe reaction.
How to prevent a migraine attack?
- OTC pain killers need careful administration. Excessive use can lead to rebound headaches or dependence
- Women who experience migraine with auras should avoid estrogen replacement therapy because of an increased risk of ischemic stroke
- Foods and drinks like cheese, alcohol and food additives like MSG may be the cause for 30% of migraines
- Regulate your sleep cycle
- Lifestyle modification and a better diet can prove to be very helpful
Lifestyle cahnges and home remedies
- Stay in a quiet dark room
- Avoid light and sound
- Use cold compresses
- Applying pressure in painful areas also helps relieve the pain
- Keep a headache diary to help you keep track and warn you of the symptoms of migraines beforehand
- Avoid alcohol consumption
Other types of migraines
In this type of migraine attack, a person experiences weakness, paralysis, and numbness in one half of the body but is temporary. In most cases, symptoms subside after a time span of 48 to 72 hours, while the aura may disappear within 24 hours.
- Numbness in one side of the body
- Tingling in the hands or face
- Temporary paralysis
The symptoms of a hemiplegic migraine resemble stroke thus it is important to consult a doctor as soon as possible to rule out any doubt.
Ocular migraines are a rare cause of temporary vision loss in one eye. The main cause is the loss of spasm of blood vessels or loss of blood in the retinal artery or behind the eyes.
- Passing of silvery, shimmering, zig-zag lines
- Development of a temporary blind spot (scotoma)
- Feeling mentally foggy or fuzzy
This type of migraine begins in your brainstem. This may occur due to vasoconstriction of the basilar artery. Basilar migraine is different from other types due to its location of the pain. The pain is at the back of the head, on both sides, and is not throbbing in character unlike other types of migraines.
- Episodes of dizziness
- Loss of coordination
- Numbness or tingling in the hands or face
Individuals who have a history of migraines can experience an episode of vertigo and is known as vestibular migraine. An episode of Vestibular Migraine can consist of vestibular symptoms alone, such as vertigo, nausea, and vomiting, without any headache.
Vestibular symptoms are mainly experienced, some of these are as follows:
- Motion sickness associated with the movement of the head
- Dizziness by looking at moving objects
- Loss of balance
- Tinnitus and feeling of fullness in the ears
- Partial or complete distortion of hearing
These migraines usually occur 2,3 days before or during the start of menstruation also known as hormone headache. The main culprit for these migraines is a drop in estrogen levels just before menstruation. Period migraines are different from normal migraines and are frequently more severe and last longer. However, period migraines can be treated with the same medication as for other migraines.
Migraine-like attacks missing one of the features required to fulfill the criteria for stating a headache as migraine is better classified into probable migraines. Attacks treated early or mild attacks do not fulfill the criterion required to be put into the category of migraine and are thus probable migraines
These can be present in two forms
- with auras
- without auras
Stress migraine is not a type of migraine. The most common trigger of migraine is stress thus such migraines are called stress migraines or tension headache. For a person who has such frequent headaches, yoga and meditation are the best contemporary methods of pain and stress relief.
Migraines with auras have all the features of migraine without auras, with some additional neurological symptoms. Auras come up as warning signs 15 to 20 minutes (in some cases) a day before migraine and include visual symptoms, phonophobia, nausea and change in taste and smell.
Stay in a quiet dark room
Avoid light and sound
Use cold compresses
Applying pressure at painful areas also help relieve the pain
Throbbing or steady pain
Nausea and vomiting
Irritability and low mood
Low blood pressure
Sensitivity to light and sound
Women who experience migraines with auras should avoid estrogen replacement treatment because of increased risk of ischemic stroke
Foods and drinks like cheese, alcohol and food additives like MSG may be the cause for 30% of migraines
Regulate your sleep cycle
Lifestyle modification and better diet can prove to be very helpful
If you suffer from a migraine attack 15 or more days a month for at least three months, they’re considered chronic and need special medical attention which includes booking an appointment with your physician as soon as possible.
This is a combination of acetaminophen, aspirin, and caffeine.